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Patent

  1. Avancerad patentsökning
PublikationsnummerUS6283983 B1
Typ av kungörelseBeviljande
AnsökningsnummerUS 09/192,554
Publiceringsdatum4 sep 2001
Registreringsdatum10 aug 1998
Prioritetsdatum13 okt 1995
AvgiftsstatusBetald
Även publicerat somWO2000009195A1
Publikationsnummer09192554, 192554, US 6283983 B1, US 6283983B1, US-B1-6283983, US6283983 B1, US6283983B1
UppfinnareJoshua Makower, Robert S. Schwartz, David R. Holmes, Robert A. Van Tassel
Ursprunglig innehavareTransvascular, Inc.
Exportera citatBiBTeX, EndNote, RefMan
Externa länkar: USPTO, Överlåtelse av äganderätt till patent som har registrerats av USPTO, Espacenet
Percutaneous in-situ coronary bypass method and apparatus
US 6283983 B1
Sammanfattning
Methods and devices for percutaneous, in situ coronary bypass wherein a tissue puncturing catheter is used to form blood flow paths between an artery and an adjacent vein such that arterial blood will flow through a segment of the adjacent vein, thereby bypassing a lesion in the artery. The tissue puncturing catheter comprises a flexible catheter having a tissue puncturing apparatus such as a sharp tipped member, an electro-surgical apparatus or a laser beam passable therefrom to create the desired blood flow paths between the artery and vein. Stents are provided for facilitating blood flow through the blood flow paths and the segment of the vein used as the bypass conduit. One such stent is specially constructed to carry arterial blood in one direction through the vein segment while allowing venous blood to continue to flow in the opposite direction through that venous segment.
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Anspråk(16)
What is claimed is:
1. A method for percutaneous, in-situ coronary bypass in a a lesion located in a coronary artery of a mammalian patient, said method comprising the steps of:
(A) providing a flexible catheter which has a tissue piercing instrument passable therefrom;
(B) inserting said catheter into the vasculature and positioning at a first location within a coronary blood vessel;
(C) passing the tissue piercing instrument from the catheter to form a blood flow path between the coronary artery proximal to the lesion and a coronary vein;
(D) repositioning the catheter at a second location within a coronary blood vessel; and,
(E) passing the tissue piercing instrument from the catheter a second time to form a second blood flow path between the coronary artery distal to the lesion and said coronary vein.
2. The method of claim 1 further comprising the step of:
(F) placing a blocking stent in said coronary vein proximal to the proximal blood flow path formed in Step C.
3. The method of claim 1 further comprising the step of:
(F) placing an elongated stent such that it extends through the blood flow paths created in Steps C and E and through the segment of said vein between said blood flow paths.
4. The method of claim 3 wherein the stent placed in step F comprises:
a braided tubular core covered by a fluid impervious layer.
5. The method of claim 4 wherein the fluid impervious layer of the stent is treated to encourage endothelial cell growth.
6. The method of claim 3 wherein the stent placed in Step F is configured to carry arterial blood in one direction through said segment of said coronary vein while allowing venous blood to naturally flow in the other direction through said segment of said coronary vein.
7. A stent for use in an in-situ arterial bypass, the bypass extending from the lumen of an artery, through a first opening in an artery wall, through the lumen of an adjacent vein and into the lumen of an artery through a second opening in an artery wall, the stent comprising:
an elongate, flexible tubular member having an interior surface, an exterior surface, a first end, a second end, and a hollow interior passage extending therethrough from the first end to the second end, the first and second ends being sized to engage the first and second artery wall openings and prevent longitudinal movement of the stent following implantation and the portion of the stent that extends between its first and second ends being sized relative to the diameter of the vein lumen such that arterial blood will be channeled through the stent in a direction opposite normal venous flow and venous blood will be permitted to flow through the vein lumen, past the stent, in the direction of normal venous flow.
8. The stent of claim 7, wherein cuffs are provided on the first and second ends of the tubular member.
9. The stent of claim 7, wherein disks are provided on the first and second ends of the tubular member.
10. The stent of claim 7, wherein laps are provided on the first and second ends of the tubular member.
11. The stent of claim 7, wherein flanges are provided on the first and second ends of the tubular member.
12. The stent of claim 7, wherein the tubular member comprises a braided tubular core covered by a fluid impervious layer.
13. The stent of claim 12, wherein the fluid impervious layer is treated so as to encourage endothelial cell growth thereon.
14. The stent of claim 12, wherein the first and second ends of the tubular member are selected from the group of structures consisting of:
a disk structure;
a cuff structure;
a lap structure; and
a flange structure.
15. The stent of claim 7, wherein the tubular member has a diameter that is smaller than the diameter of the lumen of the vein such that venous blood is permitted to flow through the vein when the stent is in the bypass position.
16. The stent of claim 15, wherein the first and second ends of the tubular member are selected from the group of structures consisting of:
a disk structure;
a cuff structure;
a lap structure; and
a flange structure.
Beskrivning
RELATED APPLICATION

This application is a continuation-in-part of application Ser. No. 08/730,496 entitled Method for Interstitial Transvascular Intervention (as amended), filed on Oct. 11, 1996, now U.S. Pat. No. 5,830 222 with a claim of priority to provisional application 60/005,164 filed on Oct. 13, 1995. The entire disclosure of such related patent application is expressly incorporated herein by reference.

BACKGROUND OF THE INVENTION

I. Field of the Invention

This invention relates generally to myocardial revascularization cardiac surgery, and more particularly to an improved method and apparatus for performing coronary lesion bypass to restore patency to blocked coronary or stenotic arteries.

II. Discussion of the Prior Art

Coronary artery disease is a major cause of death in the United States. The disease results in the build-up of calcified, fibrous and fatty deposits on the walls of the coronary arteries supplying blood to the myocardium. The narrowing of one or more cardiac arteries often results in ischemia, leading to angina pain. Moreover, clots may result in blockage of the flow of blood through a blood vessel that has been narrowed by the stenotic lesion, resulting in myocardial infarction or unstable angina.

One approach for restoring patency to a narrowed coronary artery is commonly referred to as “balloon angioplasty”. Here, a catheter having an inflatable expanding member on its distal end is routed through the vascular system until the yet uninflated member is juxtaposed with the lesion to be treated. Saline and/or contrast is then introduced through a lumen in the catheter to the interior of the expander member with sufficient pressure to inflate the expander member and fracture or compress the lesion into the wall of the blood vessel. When the expander member is deflated and the catheter removed from the patient, patency is restored to the affected coronary artery.

Not all patients suffering from coronary artery disease are candidates for balloon angioplasty. A significantly more invasive procedure, commonly referred to as coronary bypass surgery, may then be called for. In this procedure, the sternum is divided and retractors are used to expose the chest cavity. The pericardial sack is opened and the patient is placed on a heart/lung machine, allowing the patient's own heart to be stopped. A vascular segment, which may be harvested from the patient's saphenous vein or the internal mammary or radial artery, is then anastomosed to the blocked artery beyond the point of obstruction to thereby provide a shunt blood path along that lesion. Once the necessary bypass segment(s) have been sutured in place, the heart is then restarted, the chest wall is reanastomosed together and the surgical incision closed.

Such coronary bypass surgery is not only quite expensive in terms of medical costs, but also in terms of the relatively lengthy time required for recuperation.

A need exists for a less traumatic coronary bypass procedure. Some medical centers have recently reported on minimally invasive surgery wherein the bypass procedure is conducted through a relatively small wound in the chest and rib cage, with drugs being given to slow the heart rate. At this point, however, such a procedure is not widely practiced and can only be performed in selective cases where reasonable access can be had to the coronary artery containing the stenotic lesion.

A real need exists for a catheter based procedure for performing coronary bypass in those cases where balloon angioplasty is determined to be ineffective. It is the principal purpose or object of the present invention to provide such a new technique as well as instruments and devices for carrying out the procedure.

SUMMARY OF THE INVENTION

We have developed a procedure which we call “percutaneous in-situ bypass surgery” which will be referred by the acronym, PIBS. Referring to FIGS. 1 and 2, which respectively show the anterior and posterior view of a human heart, it can be noted that the major coronary arteries and branches thereof are physically located in close and generally parallel proximity to corresponding venous structures. Thus, with reference to FIG. 1, the left anterior descending coronary artery runs generally parallel with the anterior descending vein of the heart across the left ventricle and, similarly, in FIG. 2, the right coronary artery is closely juxtaposed to the small veins of the heart. The posterior interventricular branch of the right coronary artery extends generally parallel to the middle vein of the heart on the posterior side of the right ventricle. The circumflex branch of the left coronary artery generally underlies the great vein of the heart.

The fundamental principle involved in the PIBS procedure of the present invention is to utilize a coronary vein as a conduit, either to convey arterial blood directly around an arterial stenosis or occlusion or to use the vein as a chamber in which to place an arterial conduit, such as a tubular stent, and where the procedure can be performed entirely percutaneously.

In accordance with one aspect of the invention, the coronary artery is connected to the neighboring vein proximal to a stenosis or occlusion and the vein is then reconnected to the affected artery distal to the occlusion. In carrying out the method, an elongated instrument, much like a conventional guide wire, is routed through the vascular system and through the ostium of the stenosed artery until the tip thereof is proximal to the lesion to be bypassed. Either the guide wire itself or an instrument carried by the guide wire may be used to pierce through the artery wall and through a wall of the neighboring vein. A stent delivery catheter is then routed over the guide wire until the tubular stent bridges the surgically created openings in the artery and vein and the stent is deployed at this point to create a blood impervious channel. The guide wire may then be advanced down the vein to a location distal of the arterial blockage and, again, the guide wire or another instrument is deployed over the guide wire to puncture through the vein wall and the neighboring arterial wall. Again, a second stent is then inserted to anastomose the opening in the vein and the opening in the artery. As a result, a blood flow path is created from the artery through the vein segment bypassing the lesion in the artery and then back into the artery distal of the blockage. A blocking stent may be placed in the coronary vein proximal to the anastomosis to prevent arterial blood flow back to the right ventricle via the coronary sinus.

In accordance with a closely related procedure, a vein segment is again used as a conduit but, in this case, the vein merely serves as a conduit for an arterial graft. In accordance with this second procedure, the artery is entered, a hole is again made through the artery wall and through the neighboring vein wall using a percutaneous approach with the piercing instrument also being used to puncture through the vein wall and the neighboring arterial wall at a location distal of the blockage. An elongated stent having its proximal end in the artery and extending through the first puncture wounds and through the lumen of the neighboring vein and its distal end extending through the puncture in the vein and into the neighboring artery, provides a bypass path for arterial blood flow.

The stent(s) may be either of the self-expanding type or a stent delivery catheter preferably having two balloon expanders thereon for expanding the proximal and distal stents may be utilized. To enhance the compatibility of the stent or stents employed with the adjacent natural tissue and with blood, they may first be covered with a blood impervious layer. Then, by using novel materials technology, endothelialization of both surfaces of the stent conduit can occur and will develop and maintain both a neointimal lining and an external endothelium as well.

Another special instrument to be used in carrying out the method of the present invention resides in a catheter to be used in placing the puncturing instrument at the desired locations proximal to and distal to the lesion being bypassed. The guiding catheter may have two lumens, a central lumen capable of accepting a standard guide wire and a second carrying the wire for piercing through the blood vessel walls. The piercing instrument may include a mechanical cutting device on its distal end or, alternatively, may comprise an electrosurgical electrode or a laser beam directed through an optical fiber, either of which can be used to burn through the blood vessel walls.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a posterior view of the heart;

FIG. 2 is an anterior view of the heart;

FIG. 3 is a greatly enlarged view of a portion of a coronary artery and an associated vein helpful in understanding the method of the present invention in accordance with a first procedure;

FIG. 4 is a view similar to FIG. 3 helpful in understanding the method of the present invention in accordance with an alternative procedure;

FIG. 5 is a perspective view of a guide catheter, guide wire and blood vessel puncturing instrument for use in carrying out the method of the present invention;

FIG. 6 is a cross-sectional view of the distal end portion of the instrument of FIG. 5;

FIG. 7 is a side elevation view of a cuff link stent;

FIG. 8 is a side view of the stent of FIG. 7;

FIG. 9 is a partial cross-sectional view of an alternative stent device;

FIG. 10 is a partial side elevation view of an instrument useful in carrying out the method of the present invention;

FIG. 11 is a partial side elevation view of another instrument useful in carrying out the method of the present invention;

FIG. 12 is a perspective view of a bifurcated stent useful in performing the PIBS procedure; and

FIG. 13 is an enlarged view of the myocardium showing an alternative variation of the PIBS procedure.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring first to FIG. 3, an explanation will be given of the PIBS procedure of the present invention in accordance with a first procedure. There is shown in cross section a greatly enlarged section of a coronary artery 10 that is substantially blocked by a stenotic lesion 12. Located closely adjacent the arterial segment 10 is a venous segment 14. To percutaneously bypass the stenotic lesion 12, a catheter-like instrument, such as is shown in FIGS. 5 and 6, is used. It is designed to be introduced into the vascular system using the Seldinger technique. First, a radiopaque guide wire 16 is fed through an introducer and advanced through the vascular system and through the coronary ostium until the distal end of the guide wire 16 approaches the stenotic lesion 12 proximally thereof. The guide wire, being radiopaque can readily be viewed on a fluoroscope. Next, a guide catheter 18 may be fed over the proximal end of the guide wire and advanced there along. The guide catheter 18 has a side exit port 22 located a predetermined distance proximal of the distal end thereof connected to an internal lumen 24 (FIG. 11). A working catheter 26, which may comprise an electrosurgical device having either monopolar or bipolar electrode(s) as at 28 and 30 at its distal end, is-retracted so that the distal end portion thereof is fully contained within the lumen 24 as the guiding catheter 18 is being advanced over the guide wire 16. The working catheter 26 has a plug 32 at its proximal end which is adapted to be connected to terminals of an electrosurgical generator (not shown). An optical fiber driven by an external laser may also be used. Once the distal end 34 of the guiding catheter 18 is brought into close engagement with the proximal side of the stenotic lesion 12, the working catheter 26 may be advanced in the distal direction such that the distal electrodes 28 and 30 come into engagement with a diverter plug 36 placed in the lumen 24 just distal of the exit port 22. The diverter plug causes the distal end of the working catheter 26 to exit the port 22 at generally a right angle of the longitudinal axis of the catheter. When it is brought into contact with the inside wall of the artery 10 and the electrosurgical generator is actuated, the needle electrode 30 will cooperate with the electrode 28 as a bipolar pair and will effectively ablate the arterial wall and through the wall of the adjacent vein 14. Persons skilled in the art can appreciate that the electrosurgical vessel puncturing device may be monopolar and that a laser feeding it energy through a long, flexible optical fiber can also be used to effect the openings formed in the atrial and venous walls.

Following the formation of openings in the artery wall and vein wall at the site proximal to the stenotic lesion, the guiding catheter 18 can be advanced through the openings thus formed until the exit port 22 is located just distal of the stenotic lesion. Suitable radiopaque marking bands, as at 38, disposed about the exit port 22 serve to locate the exit port when viewed fluoroscopically. The procedure is repeated with the electrosurgical catheter 26 being again advanced so that its distal end exits the port 22, whereupon the electrosurgical generator is again activated to create a sufficient RF voltage between the needle electrode 30 and the return electrode 28 to penetrate through the venous wall and then through the arterial wall.

At this point, the electrosurgical catheter 26 (or laser fiber as the case may be) may be stripped out from the lumen 24 and replaced with a conventional stent delivery catheter carrying a pair of self-expanding “cuff-link” stents, such as depicted in FIGS. 7 and 8 of the drawings. The tubular stent 39 is preferably a self-expandable, double disk device made from braided stainless steel or Nitinol wire, the two disks 40 and 42 being linked together by a short tubular connecting waist 43 corresponding to the size of the surgically created openings in the wall of the artery 10 and the vein 14. The diameter of the disks 40 and 42 may be about 3-5 mm and the lumen 37 thereof may have a diameter of about 2-4 mm. The lap or flange on the proximal and distal ends of the stent prevent it from migrating with blood flow into the vein. The stent material preferably has a three-dimensional nature, permitting marked tissue ingrowth so that the neointima can support the connection without developing stenosis. The stent material also has non-porous, impermeable sides to prevent stenotic AV connections. The porosity of the covered stent material is important to permit tissue ingrowth for anchoring within a relatively short time period.

Typically, for delivery, the stent of FIG. 7 will be stretched longitudinally sufficiently so that the disk-like end portions 40 and 42 will be of a sufficiently reduced diameter so as to fit within the lumen of a 6-8 Fr. delivery catheter. Upon advancement of the stent out from the distal end of the delivery catheter, it will assume a shape like that of FIG. 7 due to the memory property of the Nitinol wire from which the stent is initially braided.

If non-self-expanding stents are employed, such as covered Palmaz stents, then the stent delivery catheter will include one or more balloons at the distal end thereof with the yet unexpanded stent(s) fitted over the balloon(s). The stent delivery catheter may then be steered so that the stent spans the distance between the artery and the vein to be anastomosed. Inflation of the balloon will then radially expand the stent to lodge it in place. With this arrangement, the balloons may be on the exterior of either the guide 18 or the cutting catheter 26 which then also function as the stent delivery device.

When the stent delivery catheter (not shown) has been advanced through the lumen 24 of the guide catheter 18 sufficiently far to engage the diverter plug 36, its distal end will be directed normal to the longitudinal axis of the guide catheter 18. Now, when the stent device of FIGS. 7 and 8 has been inserted through the openings formed through the venous and arterial walls, the stent will be deployed, such that the flared end portions 40 and 42, respectively, reside in the lumen of the vein 14 and the lumen of the artery 10 as shown in FIG. 3.

Having deployed the first cuff-link stent in a location distal of the lesion 12, the stent delivery catheter can be retracted back through the exit opening 22 until fully contained within the lumen 24. Next, the assembly including the guide catheter 18 and the stent delivery catheter can be retracted until the exit opening 22 in the guide catheter resides in the lumen of the artery 10 just opposite the surgically created openings at the location proximal to the stenotic lesion. Now, again, the stent delivery catheter is advanced in the distal direction and is steered out through the exit opening by the diverter plug 36 in the guide catheter. Now, the second stent contained within the delivery catheter is deployed so as to bridge the openings in the arterial and venous walls. When using the above-described method illustrated diagrammatically in FIG. 3, the size of the orifice 37 formed in the stent can be controlled to limit the pressure to which the venous segment will be exposed when coupled in fluid communication with the artery. Moreover, it is necessary to block flow of arterial blood from the vein to the right atrium so that venous pressure/flow remain normal. Thus, an occlusive stent or plug, as at 44, is disposed in the branch of the vein 14 leading back to the right atrium. The presence of the occluding stent will not prevent venous blood from returning to the right atrium for subsequent oxygenation because the heart possesses a highly redundant mechanism called the Thebesian venous system. Earlier studies reported in the literature have shown that if the epicardial Great Cardiac Vein (see FIG. 1) is occluded, coronary venous return drops by only about 15 percent.

An alternative approach for performing the PIBS procedure will now be explained with the aid of FIG. 4. Illustrated there is a portion of the myocardium 50 supporting a coronary artery 10′ and an adjacent, parallel vein 14′. The arterial segment 10′ is shown as having a stenotic lesion 12′ partially or fully blocking flow through the artery 12′.

The first step in the procedure would be to enter the coronary artery in a standard fashion, such as by puncturing the femoral artery and introducing a guide wire 16. The guide wire is advanced until its distal end is disposed proximate the lesion 12′ and following that, the guide catheter 18 is inserted and routed over or along the guide wire until its outlet port 22 is positioned slightly upstream of the lesion to be bypassed. The catheter 26 carrying a cutting instrument on its distal end is then advanced through the lumen 24 of the guide catheter until its distal end abuts the diverter plug 36 which causes the distal end of the catheter 26 to project outward normal to the guide catheter and against the arterial wall. The distal end of the catheter 26,is made to puncture through both the arterial wall and the adjacent venous wall. The physician will next draw back on the proximal end portion of the catheter 26 until its distal end again is fully contained within the lumen of the guide catheter 18. The guide catheter 18 will -then be advanced through the puncture openings just created and through the lumen of the vein 14′ until its outlet port 22 is located just distal of the occlusion 12′. At this point, the catheter 26 will again be advanced so as to project out through the exit port 22 formed through the side wall of the guide catheter and the cutting instrument on the end thereof is again used to create openings through the venous wall and the arterial wall.

At this point, the catheter 26 may be removed completely from the lumen 24 and replaced with a stent delivery catheter of known, conventional form. Here, instead of using two small cuff link stents, such as shown in FIGS. 7 and 8, an elongated stent 52 is deployed, such that its proximal end remains in the arterial lumen while the remaining portion of the stent is advanced through the lumen of the vein 14′ and with the stent's distal end being brought through the surgically created openings in the vein and artery located just distal of the stenotic lesion 12′. Proximal and distal ends 54, 56 of the stent 52 are desirably radially larger than the remaining tubular portion therebetween, or include cuffs, disks, laps, or flanges as with the cuff-link stents 39 of FIG. 3, to prevent the stent from migrating due to blood flow in the vein 14′. Thus, a single tubular stent, such as is represented in FIG. 4, provides a shunt path around the lesion 12′. As shown in FIG. 9, the stent 52 preferably comprises a braided tubular core 54 which is covered by a fluid impervious layer 56. The inside of the layer.56 is treated so as to encourage endothelial cell growth for stabilizing the stent in place. With the approach shown in FIG. 4, it is no longer necessary to block the venous channel leading back to the right atrium. The interior of the venous conduit 14′ is not exposed to arterial blood pressures in that the channel for flow of the arterial blood is through the lumen of the stent device 52.

FIG. 10 illustrates a cutting catheter 26′ that uses straight mechanical cutting rather than an electrosurgical approach. It comprises an outer tubular sheath 58 coaxially surrounding an elongated, pushable, torqueable tubular member 60 having a cutting blade 62 affixed to the distal end thereof, the cutting blade also being tubular, but with a tapered leading edge 64 and a pointed tip 66. The tapered edge 64 is beveled to be razor-sharp. Because both the elongated member 60 and the cutting blade 62 are tubular, a guide wire 16 may be used for facilitating the routing of the instrument 26′ through the vascular system. During the advancement of the instrument through the vascular system, the blade portion 64 will be fully retracted within the sheath 26′ and will only be deployed when properly positioned for cutting through the arterial and venous walls.

FIG. 11 is a partial view of the distal end portion of an electrosurgical cutting instrument. This instrument also comprises an outer tubular sheath 58′ having a two conductor cable 68 extending from a. proximal end thereof and with the individual conductors 70 and 72 thereof being brought out and connected respectively to a conductive end cap 28 disposed on the distal end of the sheath 58′ and to the needle electrode 30. The needle electrode 30 is preferably retractable through an insulated bushing 74 formed into an aperture in the conductive end cap 28 allowing the needle electrode to be selectively advanced outward from the distal end of the cap 28 without shorting against it.

The needle electrode 30 may comprise an exposed distal metal end portion of an otherwise insulation coated guide wire which may be made to extend out from the end cap 28 on the sheath 58 when it is to be used to perform electrosurgical cutting of the blood vessel walls. Subsequently, however, the guide wire may be extended further in the distal direction through the surgically created openings to be used in guiding the sheath 58′ to the distal site and then again used to create the openings through the walls of the vein and artery.

A bifurcated stent, such as that shown in FIG. 12, may also be used to anastomose the surgically created opening in the arterial and venous walls. In use, the leg 45 may be deployed entirely within the lumen of the artery at a location proximal to the stenotic lesion with the branch 47 extending through the surgically created openings in the arterial and venous wall. Similarly, to anastomose the surgically created openings in the vein and artery walls distal to the stenotic lesion, the leg 45 may be positioned wholly within the lumen of the vein with the branch 47 extending through the surgically created openings.

The description of the PIBS procedure set out above presumes the presence of a closely adjacent vein to the artery containing the occlusion to be bypassed. In instances where an occlusion appears at a location in an artery that is spaced some distance from a vein but where an arterial branch proximal to the lesion intersects with a vein that approximates the artery containing the occlusion, the above-described PIBS procedure may be used by puncturing and later anastomosing the arterial branch with the vein at the point of intersection and then joining the vein to the artery distal of the occlusion. In this regard, reference is made to FIG. 13 which is a greatly enlarged view of a portion of the myocardium and illustrating the above-described vein-artery relationship. Here, a coronary artery 100 has a stenotic lesion 102 in a bifurcated branch 104 thereof and proximal to the lesion 102 is another arterial branch 106 that crosses a vein segment 108. By creating an opening in the wall of the arterial branch 106 and the vein 108 at the location of the intersection and anastomosing the two using a stent or otherwise, and then doing the same at a location distal to the lesion 102, an arterial blood supply will be established from the artery 100 through the arterial branch 106 and the vein 108 back to the arterial branch 104 at a location distal of the obstruction 102.

To assist in locating the point of intersection of the arterial branch 106 and the vein 108, a guide wire 110 may be passed down the vein 108. Next, the guide catheter 18 will be routed through the arterial branch 100 and into the branch 106. The guide catheter 18 of FIG. 6 is equipped with a suitable transducer at its distal end capable of sensing its proximity to the metal guide wire 110. The location where the signal output from the transducer is a maximum will pinpoint the location of the intersection and the cutting catheter 26 may then be deployed to create the surgical openings in the arterial branch 106 and the vein 100 which then may be stented. The guide 18 and the cutting catheter 26 may then be routed through that opening and down the vein 108 to a location 112 where the vein and adjacent artery are again punctured and stented. The transducer, for example, may be a Doppler device, an ultrasonic transducer, a Hall effect magnetic transducer, or an rf transmitter that utilizes the guide wire 110 as a receiving antenna.

A catheter for cannulating the coronary sinus, with specific intent for support of stent placement may access the coronary sinus either from the superior vena cava or the inferior vena cava and preferably has a long, more flexible tip of 2 to 5 cms so that it will carefully track as it is advanced into the coronary sinus. It can also be used to track into smaller coronary veins. Since the tip is highly flexible and very soft, it is atraumatic and will gently track either on its own, or over a guide wire.

Also facilitating the PIBS procedure is a coronary venous angiographic catheter that can be used to visualize the coronary venous tree with an injection of a contrast media. Because of retrograde flow, the coronary venous angiographic catheter will preferably have an occlusion mechanism, such as an inflatable balloon on its periphery. With the vein occluded, the contrast media is injected retrograde as the injection is recorded by fluoroscopic imaging.

The PIBS procedure described herein affords numerous advantages over conventional open-heart surgery when performing coronary bypass. The procedure is simple and safe, and even if a difficulty arises during the procedure, the patient is no worse off than prior to the procedure in that the open heart approach is always available as a back-up. The procedure of the present invention is quite simple and can be done with a patient awake and with only a local anesthetic used at the point of percutaneous entry. The hospital stay could conceivably be reduced to a single day and the period for full recuperation is significantly less than is required when open heart surgery is employed. Further, the procedure is independent of lesion morphology and can be used with total occlusions, diffuse or long lesions and other high risk or dangerous morphologies. By limiting the pressure in the veins, they can expected to function naturally. The my r epicardial arteries always have a corresponding vein very close by, making the procedure practical.

Citat från patent
citerade patent Registreringsdatum Publiceringsdatum Sökande Titel
US5064435 *28 jun 199012 nov 1991Schneider (Usa) Inc.Self-expanding prosthesis having stable axial length
US5797920 *23 aug 199625 aug 1998Beth Israel Deaconess Medical CenterCatheter apparatus and method using a shape-memory alloy cuff for creating a bypass graft in-vivo
US583022211 okt 19963 nov 1998Transvascular, Inc.Device, system and method for intersititial transvascular intervention
WO1997013463A111 okt 199617 apr 1997Transvascular, Inc.Methods and apparatus for bypassing arterial obstructions and/or performing other transvascular procedures
WO1997013471A111 okt 199617 apr 1997Transvascular, Inc.A device, system and method for interstitial transvascular intervention
WO1997027893A131 jan 19977 aug 1997Transvascular, Inc.Methods and apparatus for blocking flow through blood vessels
WO1997027897A131 jan 19977 aug 1997Transvascular, Inc.A device, system and method for interstitial transvascular intervention
WO1997027898A131 jan 19977 aug 1997Transvascular, Inc.Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures
WO1998008456A125 aug 19975 mar 1998Transvascular, Inc.Methods and apparatus for transmyocardial direct coronary revascularization
WO1998046115A213 apr 199822 okt 1998Transvascular, Inc.Methods and apparatus for transmyocardial direct coronary revascularization
WO1998046119A110 apr 199822 okt 1998Transvascular, Inc.Catheters and related devices for forming passageways between blood vessels or other anatomical structures
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US6409751 *14 nov 200025 jun 2002Percardia, Inc.Stent delivery system and method of use
US651145819 jan 200128 jan 2003Lumend, Inc.Vascular re-entry catheter
US6537300 *30 maj 200125 mar 2003Scimed Life Systems, Inc.Implantable obstruction device for septal defects
US658244410 apr 200124 jun 2003Percardia, Inc.Blood flow conduit delivery system and method of use
US66050538 sep 200012 aug 2003Percardia, Inc.Conduit designs and related methods for optimal flow control
US660511310 apr 200112 aug 2003Percardia Inc.Vascular graft bypass
US661010010 apr 200126 aug 2003Percardia, Inc.Designs for left ventricular conduit
US662995118 jul 20017 okt 2003Broncus Technologies, Inc.Devices for creating collateral in the lungs
US66382371 aug 200028 okt 2003Percardia, Inc.Left ventricular conduits and methods for delivery
US66416104 aug 19994 nov 2003Percardia, Inc.Valve designs for left ventricular conduits
US66924947 aug 200017 feb 2004Broncus Technologies, Inc.Methods and devices for creating collateral channels in the lungs
US66949838 mar 200224 feb 2004Percardia, Inc.Delivery methods for left ventricular conduit
US67128124 sep 200130 mar 2004Broncus Technologies, Inc.Devices for creating collateral channels
US67496064 sep 200115 jun 2004Thomas KeastDevices for creating collateral channels
US73512474 sep 20021 apr 2008Bioconnect Systems, Inc.Devices and methods for interconnecting body conduits
US769979021 jul 200420 apr 2010Ev3, Inc.Debulking catheters and methods
US770422230 aug 200427 apr 2010Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
US77042674 aug 200427 apr 2010C. R. Bard, Inc.Non-entangling vena cava filter
US770427526 jan 200727 apr 2010Reva Medical, Inc.Circumferentially nested expandable device
US770871219 jul 20044 maj 2010Broncus Technologies, Inc.Methods and devices for maintaining patency of surgically created channels in a body organ
US770874914 dec 20044 maj 2010Fox Hollow Technologies, Inc.Debulking catheters and methods
US771327922 apr 200311 maj 2010Fox Hollow Technologies, Inc.Method and devices for cutting tissue
US772266213 okt 200625 maj 2010Reva Medical, Inc.Expandable stent with sliding and locking radial elements
US77363279 maj 200815 jun 2010Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
US776306521 jul 200427 jul 2010Reva Medical, Inc.Balloon expandable crush-recoverable stent device
US777144419 dec 200110 aug 2010Fox Hollow Technologies, Inc.Methods and devices for removing material from a body lumen
US779441321 sep 200514 sep 2010Ev3, Inc.Libraries and data structures of materials removed by debulking catheters
US779447312 nov 200414 sep 2010C.R. Bard, Inc.Filter delivery system
US781565611 aug 200619 okt 2010Medtronic Vascular, Inc.Method for endovascular bypass stent graft delivery
US78875564 nov 200215 feb 2011Fox Hollow Technologies, Inc.Debulking catheters and methods
US78922464 sep 200222 feb 2011Bioconnect Systems, Inc.Devices and methods for interconnecting conduits and closing openings in tissue
US78922473 okt 200222 feb 2011Bioconnect Systems, Inc.Devices and methods for interconnecting vessels
US79145742 aug 200529 mar 2011Reva Medical, Inc.Axially nested slide and lock expandable device
US791887011 sep 20065 apr 2011Bridgepoint Medical, Inc.Endovascular devices and methods
US792778410 jan 200619 apr 2011Ev3Vascular lumen debulking catheters and methods
US793881911 sep 200610 maj 2011Bridgepoint Medical, Inc.Endovascular devices and methods
US79470719 okt 200924 maj 2011Reva Medical, Inc.Expandable slide and lock stent
US795529323 aug 20067 jun 2011Flowcardia, Inc.Ultrasound catheter for disrupting blood vessel obstructions
US79887214 dec 20072 aug 2011Reva Medical, Inc.Axially-radially nested expandable device
US7989207 *17 feb 20062 aug 2011Tyco Healthcare Group LpTesting lumenectomy samples for markers of non-vascular diseases
US801684225 mar 200813 sep 2011Medtronic Vascular, Inc.Methods for treating vulnerable plaque
US802565511 sep 200627 sep 2011Bridgepoint Medical, Inc.Endovascular devices and methods
US80432517 aug 200925 okt 2011Flowcardia, Inc.Ultrasound catheter and methods for making and using same
US80527042 nov 20078 nov 2011Foxhollow Technologies, Inc.High capacity debulking catheter with distal driven cutting wheel
US806256625 jul 200622 nov 2011Flowcardia, Inc.Method of manufacturing an ultrasound transmission member for use in an ultrasound catheter device
US808372711 sep 200627 dec 2011Bridgepoint Medical, Inc.Endovascular devices and methods for exploiting intramural space
US81332367 nov 200613 mar 2012Flowcardia, Inc.Ultrasound catheter having protective feature against breakage
US81527537 aug 200910 apr 2012Flowcardia, Inc.Ultrasound catheter and methods for making and using same
US817286327 apr 20098 maj 2012Bridgepoint Medical, Inc.Methods and apparatus for crossing occlusions in blood vessels
US817289426 apr 20108 maj 2012Reva Medical, Inc.Circumferentially nested expandable device
US819245214 maj 20105 jun 2012Tyco Healthcare Group LpEasily cleaned atherectomy catheters and methods of use
US82022464 feb 200919 jun 2012Bridgepoint Medical, Inc.Crossing occlusions in blood vessels
US821617430 apr 201010 jul 2012Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
US822134320 jan 200517 jul 2012Flowcardia, Inc.Vibrational catheter devices and methods for making same
US822656612 jun 200924 jul 2012Flowcardia, Inc.Device and method for vascular re-entry
US82266749 apr 201024 jul 2012Tyco Healthcare Group LpDebulking catheters and methods
US824664018 maj 200621 aug 2012Tyco Healthcare Group LpMethods and devices for cutting tissue at a vascular location
US824664318 jul 200821 aug 2012Flowcardia, Inc.Ultrasound catheter having improved distal end
US825738230 mar 20084 sep 2012Boston Scientific LimitedLumen reentry devices and methods
US825738330 mar 20084 sep 2012Boston Scientific LimitedLumen reentry devices and methods
US82679544 feb 200518 sep 2012C. R. Bard, Inc.Vascular filter with sensing capability
US827750020 jun 20062 okt 2012Reva Medical, Inc.Slide-and-lock stent
US829294417 dec 200423 okt 2012Reva Medical, Inc.Slide-and-lock stent
US83086773 jun 201113 nov 2012Flowcardia, Inc.Ultrasound catheter for disrupting blood vessel obstructions
US832326111 sep 20064 dec 2012Bridgepoint Medical, Inc.Methods of accessing an intramural space
US83288292 nov 200711 dec 2012Covidien LpHigh capacity debulking catheter with razor edge cutting window
US83374255 aug 200925 dec 2012Bridgepoint Medical, Inc.Endovascular device with a tissue piercing distal probe and associated methods
US83666514 aug 20085 feb 2013Bioconnect Systems, Inc.Implantable flow connector
US837210918 mar 201012 feb 2013C. R. Bard, Inc.Non-entangling vena cava filter
US838858130 jun 20035 mar 2013Biocardia, Inc.System for treating the heart with potentially embolic agents through a right heart approach
US84091675 okt 20062 apr 2013Broncus Medical IncDevices for delivering substances through an extra-anatomic opening created in an airway
US841460413 okt 20099 apr 2013Covidien LpDevices and methods for manipulating a catheter shaft
US843090318 nov 201130 apr 2013C. R. Bard, Inc.Embolus blood clot filter and delivery system
US846036329 jul 201111 jun 2013Reva Medical, Inc.Axially-radially nested expandable device
US846997922 sep 201125 jun 2013Covidien LpHigh capacity debulking catheter with distal driven cutting wheel
US849666921 dec 200730 jul 2013Flowcardia, Inc.Ultrasound catheter having protective feature against breakage
US84966772 dec 201030 jul 2013Covidien LpMethods and devices for cutting tissue
US849667910 apr 201230 jul 2013Bridgepoint Medical, Inc.Methods and apparatus for crossing occlusions in blood vessels
US850651916 jul 200713 aug 2013Flowcardia, Inc.Pre-shaped therapeutic catheter
US851231023 nov 201120 aug 2013Bridgepoint Medical, Inc.Endovascular devices and methods for exploiting intramural space
US851239426 jul 201020 aug 2013Reva Medical Inc.Balloon expandable crush-recoverable stent device
US85239368 apr 20113 sep 2013Reva Medical, Inc.Expandable slide and lock stent
US85407627 maj 201224 sep 2013Reva Medical, Inc.Circumferentially nested expandable device
US854554723 maj 20111 okt 2013Reva Medical Inc.Expandable slide and lock stent
US85742491 maj 20125 nov 2013Covidien LpEasily cleaned atherectomy catheters and methods of use
US857426127 jun 20115 nov 2013C. R. Bard, Inc.Removable embolus blood clot filter
US859722612 jun 20123 dec 2013Jenavalve Technology, Inc.Methods and conduits for flowing blood from a heart chamber to a blood vessel
US85973151 jul 20103 dec 2013Covidien LpAtherectomy catheter with first and second imaging devices
US86087244 nov 201017 dec 2013Broncus Medical Inc.Devices for delivering substances through an extra-anatomic opening created in an airway
US861375128 jan 200824 dec 2013Flowcardia, Inc.Steerable ultrasound catheter
US861375429 jul 201024 dec 2013C. R. Bard, Inc.Tubular filter
US86170961 feb 201131 dec 2013Flowcardia, Inc.Ultrasound catheter devices and methods
US861723528 mar 201131 dec 2013Reva Medical, Inc.Axially nested slide and lock expandable device
US862855628 nov 201214 jan 2014C. R. Bard, Inc.Non-entangling vena cava filter
US863255621 okt 200821 jan 2014Bridgepoint Medical, Inc.Methods and devices for crossing chronic total occlusions
US863671219 aug 201128 jan 2014Bridgepoint Medical, Inc.Endovascular devices and methods
US86416307 jul 20104 feb 2014Flowcardia, Inc.Connector for securing ultrasound catheter to transducer
US864729322 maj 200811 feb 2014Flowcardia, Inc.Therapeutic ultrasound system
US866330122 jan 20104 mar 2014Cornell UniversityMethod and apparatus for restricting flow through an opening in the side wall of a body lumen, and/or for reinforcing a weakness in the side wall of a body lumen, while still maintaining substantially normal flow through the body lumen
US866870925 feb 200811 mar 2014Flowcardia, Inc.Steerable ultrasound catheter
US867904917 jul 201225 mar 2014Flowcardia, Inc.Device and method for vascular re-entry
US86908164 aug 20088 apr 2014Bioconnect Systems, Inc.Implantable flow connector
US86908199 nov 20128 apr 2014Flowcardia, Inc.Ultrasound catheter for disrupting blood vessel obstructions
US86909067 mar 20128 apr 2014C.R. Bard, Inc.Removeable embolus blood clot filter and filter delivery unit
US870902819 jul 201329 apr 2014Bridgepoint Medical, Inc.Methods and appartus for crossing occlusions in blood vessels
US870903413 maj 201129 apr 2014Broncus Medical Inc.Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US872167524 aug 201213 maj 2014Boston Scientific LimitedLumen reentry devices and methods
US872814111 dec 200820 maj 2014Cornell UniversityMethod and apparatus for sealing an opening in the side wall of a body lumen, and/or for reinforcing a weakness in the side wall of a body lumen, while maintaining substantially normal flow through the body lumen
US878433321 jan 200922 jul 2014Covidien LpApparatus and methods for material capture and removal
US878440016 maj 201222 jul 2014Broncus Medical Inc.Devices for delivering substances through an extra-anatomic opening created in an airway
US87844401 dec 200822 jul 2014Covidien LpMethods and devices for cutting tissue
US879029122 apr 200929 jul 2014Flowcardia, Inc.Ultrasound catheter devices and methods
US880818610 nov 201119 aug 2014Covidien LpFlexible debulking catheters with imaging and methods of use and manufacture
US891145928 jun 201216 dec 2014Covidien LpDebulking catheters and methods
US892045027 okt 201130 dec 2014Covidien LpMaterial removal device and method of use
US893231513 okt 201113 jan 2015W. L. Gore & Associates, Inc.Systems and methods for percutaneous occlusion crossing
US89323167 apr 201413 jan 2015Broncus Medical Inc.Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US89512762 nov 201210 feb 2015Avenu Medical, Inc.Systems and methods for percutaneous intravascular access and guidewire placement
US895637523 sep 201117 feb 2015Flowcardia, Inc.Ultrasound catheter devices and methods
US89564752 apr 201217 feb 2015Howard RiinaMethod and apparatus for restricting flow through an opening in the side wall of a body lumen, and/or for reinforcing a weakness in the side wall of a body lumen, while still maintaining substantially normal flow through the body lumen
US89614231 okt 200924 feb 2015Flowcardia, Inc.Ultrasound catheter apparatus
US896144616 dec 201224 feb 2015Bioconnect Systems Inc.Implantable flow connector
US896149425 okt 201224 feb 2015Bridgepoint Medical, Inc.Endovascular devices and methods for exploiting intramural space
US896154617 jul 201224 feb 2015Covidien LpMethods and devices for cutting tissue at a vascular location
US89683829 okt 20123 mar 2015Cornell UniversityMethod and apparatus for restricting flow through an opening in the side wall
US89847332 okt 201324 mar 2015Artventive Medical Group, Inc.Bodily lumen occlusion
US899256213 sep 201031 mar 2015C.R. Bard, Inc.Filter delivery system
US899271730 aug 201231 mar 2015Covidien LpCatheter with helical drive shaft and methods of manufacture
US899893728 apr 20097 apr 2015Covidien LpMethods and devices for cutting tissue
US90052254 mar 201414 apr 2015Bridgepoint Medical, Inc.Methods and appartus for crossing occlusions in blood vessels
US901735129 jun 201028 apr 2015Artventive Medical Group, Inc.Reducing flow through a tubular structure
US901736716 dec 201328 apr 2015C. R. Bard, Inc.Tubular filter
US902851218 sep 201212 maj 2015Covidien LpMaterial removal device having improved material capture efficiency and methods of use
US906080214 aug 200823 jun 2015Bridgepoint Medical, Inc.Endovascular devices and methods for exploiting intramural space
US90668274 sep 201330 jun 2015Reva Medical, Inc.Expandable slide and lock stent
US909534414 mar 20134 aug 2015Artventive Medical Group, Inc.Methods and apparatuses for blood vessel occlusion
US910766919 maj 201418 aug 2015Artventive Medical Group, Inc.Blood vessel occlusion
US911966214 jun 20111 sep 2015Covidien LpMaterial removal device and method of use
US913199917 nov 200615 sep 2015C.R. Bard Inc.Vena cava filter with filament
US913823027 apr 201222 sep 2015Avenu Medical, Inc.Systems and methods for creating arteriovenous (AV) fistulas
US91444842 jan 201429 sep 2015C. R. Bard, Inc.Non-entangling vena cava filter
US914927718 okt 20106 okt 2015Artventive Medical Group, Inc.Expandable device delivery
US914937818 aug 20086 okt 2015Reva Medical, Inc.Axially nested slide and lock expandable device
US917375113 sep 20123 nov 2015Reva Medical, Inc.Slide-and-lock stent
US919240615 mar 201324 nov 2015Covidien LpMethod for manipulating catheter shaft
US919906713 feb 20141 dec 2015Tufts Medical Center, Inc.Endovascular cerebrospinal fluid shunt
US920495613 aug 20128 dec 2015C. R. Bard, Inc.IVC filter with translating hooks
US922053027 sep 201329 dec 2015Covidien LpEasily cleaned atherectomy catheters and methods of use
US923789710 jan 201419 jan 2016Bridgepoint Medical, Inc.Endovascular devices and methods
US924173310 jun 201326 jan 2016Covidien LpDebulking catheter
US92479426 feb 20122 feb 2016Artventive Medical Group, Inc.Reversible tubal contraceptive device
US926552010 feb 201423 feb 2016Flowcardia, Inc.Therapeutic ultrasound system
US92829679 mar 201315 mar 2016Bioconnect Systems, Inc.Implantable flow connector
US92829845 apr 200615 mar 2016Flowcardia, Inc.Therapeutic ultrasound system
US930177729 jul 20135 apr 2016Invatec S.P.A.Occlusion bypassing apparatuses and methods for bypassing an occlusion in a blood vessel
US930801923 jul 201312 apr 2016Bridgepoint Medical, Inc.Endovascular devices and methods for exploiting intramural space
US930835629 jul 201312 apr 2016Invatec S.P.A.Occlusion bypassing apparatuses and methods for bypassing an occlusion in a blood vessel
US931435410 maj 201319 apr 2016Reva Medical, Inc.Axially-radially nested expandable device
US931460013 mar 201319 apr 2016Bioconnect Systems, Inc.Delivery system for implantable flow connector
US932087415 aug 201326 apr 2016Invatec S.P.A.Catheter systems with a blocking mechanism and methods for bypassing an occlusion in a blood vessel
US932678913 jun 20143 maj 2016Covidien LpFlexible debulking catheters with imaging and methods of use and manufacture
US93268424 jun 20073 maj 2016C. R . Bard, Inc.Embolus blood clot filter utilizable with a single delivery system or a single retrieval system in one of a femoral or jugular access
US934548531 jan 201524 maj 2016Bioconnect Systems, Inc.Implantable flow connector
US934553211 maj 201224 maj 2016Broncus Medical Inc.Methods and devices for ablation of tissue
US935182120 nov 201331 maj 2016C. R. Bard, Inc.Removable embolus blood clot filter and filter delivery unit
US936464214 aug 201314 jun 2016Invatec S.P.A.Balloon catheter systems and methods for bypassing an occlusion in a blood vessel
US938102723 dec 20135 jul 2016Flowcardia, Inc.Steerable ultrasound catheter
US93870635 dec 201212 jul 2016C. R. Bard, Inc.Embolus blood clot filter and delivery system
US93873119 mar 201612 jul 2016Cerevasc, LlcMethods and systems for treating hydrocephalus
US940264621 mar 20142 aug 2016Flowcardia, Inc.Device and method for vascular re-entry
US94026494 dec 20142 aug 2016W.L. Gore & Associates, Inc.Systems and methods for percutaneous occlusion crossing
US940873211 mar 20149 aug 2016Reva Medical, Inc.Reduced-profile slide and lock stent
US94210247 mar 201423 aug 2016Flowcardia, Inc.Steerable ultrasound catheter
US942107018 dec 201423 aug 2016Broncus Medical Inc.Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall
US943343330 jan 20146 sep 2016Flowcardia, Inc.Connector for securing ultrasound catheter to transducer
US943971014 nov 201313 sep 2016Avenu Medical, Inc.Intravascular arterial to venous anastomosis and tissue welding catheter
US94397284 dec 201313 sep 2016Avenu Medical, Inc.Systems for creating arteriovenous (AV) fistulas
US944583419 maj 201420 sep 2016Covidien LpMethods and devices for cutting tissue
US944586815 jun 201120 sep 2016Avenu Medical, Inc.Systems and methods for creating arteriovenous (AV) fistulas
US94462225 mar 201420 sep 2016Invatec S.P.A.Catheter assemblies and methods for stabilizing a catheter assembly within a subintimal space
US945196516 apr 201527 sep 2016Artventive Medical Group, Inc.Reducing flow through a tubular structure
US945201515 jun 201127 sep 2016Avenu Medical, Inc.Intravascular arterial to venous anastomosis and tissue welding catheter
US945206828 aug 201327 sep 2016Reva Medical, Inc.Expandable slide and lock stent
US94745628 feb 201325 okt 2016Avenu Medical, Inc.Intravascular arterial to venous anastomosis and tissue welding catheter
US948622413 feb 20158 nov 2016Cornell UniversityMethod and apparatus for restricting flow through an opening in the side wall of a body lumen, and/or for reinforcing a weakness in the side wall of a body lumen, while still maintaining substantially normal flow through the body lumen
US948622911 maj 20128 nov 2016Broncus Medical Inc.Methods and devices for excision of tissue
US948623712 jul 20138 nov 2016Covidien LpMethods and devices for cutting tissue
US94983184 nov 201322 nov 2016C.R. Bard, Inc.Removable embolus blood clot filter
US952201628 jan 201520 dec 2016Avenu Medical, Inc.Systems and methods for percutaneous intravascular access and guidewire placement
US953279913 mar 20153 jan 2017Covidien LpMethod and devices for cutting tissue
US953284413 sep 20133 jan 2017Covidien LpCleaning device for medical instrument and method of use
US953312831 okt 20123 jan 2017Broncus Medical Inc.Devices for maintaining patency of surgically created channels in tissue
US954526321 maj 201517 jan 2017Limflow GmbhDevices and methods for treating lower extremity vasculature
US954550528 jun 201617 jan 2017Cerevasc, LlcMethods and systems for treating hydrocephalus
US957915713 sep 201328 feb 2017Covidien LpCleaning device for medical instrument and method of use
US961585025 nov 201311 apr 2017Covidien LpAtherectomy catheter with aligned imager
US961590929 apr 201611 apr 2017C.R. Bard, Inc.Removable embolus blood clot filter and filter delivery unit
US962964313 jul 201225 apr 2017Flowcardia, Inc.Ultrasound catheter having improved distal end
US963611613 jun 20142 maj 2017Artventive Medical Group, Inc.Implantable luminal devices
US964915720 aug 201516 maj 2017Avenu Medical, Inc.Systems and methods for creating arteriovenous (AV) fistulas
US966247928 jun 201630 maj 2017Cerevasc, LlcMethods and systems for treating hydrocephalus
US966919510 okt 20166 jun 2017Cerevasc, LlcMethods and systems for treating hydrocephalus
US968726627 apr 201027 jun 2017Covidien LpMethods and devices for cutting and abrading tissue
US968726713 jun 201327 jun 2017Covidien LpDevice for cutting tissue
US971752017 dec 20141 aug 2017Covidien LpMaterial removal device and method of use
US971788927 apr 20151 aug 2017Bridgepoint Medical, Inc.Endovascular devices and methods for exploiting intramural space
US972450114 feb 20178 aug 2017Cerevasc, LlcMethods and systems for treating hydrocephalus
US973730613 jun 201422 aug 2017Artventive Medical Group, Inc.Implantable luminal devices
US973730710 aug 201522 aug 2017Artventive Medical Group, Inc.Blood vessel occlusion
US97373089 dec 201322 aug 2017Artventive Medical Group, Inc.Catheter-assisted tumor treatment
US973769614 jan 201522 aug 2017Tufts Medical Center, Inc.Endovascular cerebrospinal fluid shunt
US973769714 okt 201622 aug 2017Tufts Medical Center, Inc.Endovascular cerebrospinal fluid shunt
US20020007138 *10 apr 200117 jan 2002Percardia, Inc.Left ventricular conduit with blood vessel graft
US20020022788 *27 jul 200121 feb 2002Tim CorviApparatus and methods for material capture and removal
US20020077642 *19 dec 200120 jun 2002Fox Hollow Technologies, Inc.Debulking catheter
US20030088256 *3 okt 20028 maj 2003Conston Stanley R.Devices and methods for interconnecting vessels
US20030100920 *4 sep 200229 maj 2003Akin Jodi J.Devices and methods for interconnecting conduits and closing openings in tissue
US20030125758 *4 nov 20023 jul 2003Fox Hollow Technologies, Inc.Debulking catheters and methods
US20040030286 *30 jun 200312 feb 2004Biocardia, Inc.Method of treating the heart
US20040044329 *29 aug 20024 mar 2004Trudell Leonard A.Catheter for cardiac injection and method for delivery of therapeutic agents to specified tissues
US20040092844 *12 nov 200213 maj 2004Johnson Eric T.Guide catheter
US20050171478 *12 apr 20044 aug 2005Selmon Matthew R.Catheter system for crossing total occlusions in vasculature
US20050278013 *14 jul 200415 dec 2005Matthew RustMethod for endovascular bypass stent graft delivery
US20060173298 *29 okt 20033 aug 2006Tucker Kelly JIntracardiac catheter and method of use
US20060253190 *8 maj 20069 nov 2006Kuo Michael DRemoveable stents
US20070142855 *16 dec 200521 jun 2007Scott KoyshSurgical port system with marker ring
US20070203565 *11 aug 200630 aug 2007Matthew RustMethod for Endovascular Bypass Stent Graft Delivery
US20070239010 *11 apr 200611 okt 2007Medtronic Vascular, Inc.Catheters with Laterally Deployable Elements and Linear Ultrasound Arrays
US20080243065 *30 mar 20082 okt 2008Dan RottenbergLumen reentry devices and methods
US20080243067 *30 mar 20082 okt 2008Dan RottenbergLumen reentry devices and methods
US20090248049 *25 mar 20081 okt 2009Medtronic Vascular, Inc.Methods for Treating Vulnerable Plaque
US20090254105 *4 apr 20088 okt 2009Medtronic Vascular, Inc.Anastomotic connectors
US20090259174 *15 apr 200815 okt 2009Medtronic Vascular, Inc.Methods and devices for treating vulnerable atherosclerotic plaque
US20090264914 *11 dec 200822 okt 2009Howard RiinaMethod and apparatus for sealing an opening in the side wall of a body lumen, and/or for reinforcing a weakness in the side wall of a body lumen, while maintaining substantially normal flow through the body lumen
US20100191066 *1 apr 201029 jul 2010Scott KoyshSurgical port system with marker ring
US20100268260 *22 jan 201021 okt 2010Howard RiinaMethod and apparatus for restricting flow through an opening in the side wall of a body lumen, and/or for reinforcing a weakness in the side wall of a body lumen, while still maintaining substantially normal flow through the body lumen
US20110060606 *10 sep 201010 mar 2011Ev3 Inc.Libraries and data structures of materials removed by debulking catheters
WO2005039419A1 *25 okt 20046 maj 2005Ev3, Inc.Patent foramen ovale closure system
Juridiska händelser
DatumKodHändelseBeskrivning
11 maj 1999ASAssignment
Owner name: TRANSVASCULAR, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MAKOWER, JOSHUA;SCHWARTZ, ROBERT S.;HOLMES, DAVID R.;ANDOTHERS;REEL/FRAME:009951/0839;SIGNING DATES FROM 19990421 TO 19990504
26 feb 2004ASAssignment
Owner name: MEDTRONIC VASCULAR, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TRANSVASCULAR, INC.;REEL/FRAME:015000/0001
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